Improving Colorectal Cancer Screening in Primary Care Practice: Innovative Strategies and Future Directions

Abstract

Colorectal cancer (CRC) screening has been supported by strong research evidence and recommended in clinical practice guidelines for more than a decade. Yet screening rates in the United States remain low, especially relative to other preventable diseases such as breast and cervical cancer. To understand the reasons, the National Cancer Institute and Agency for Healthcare Research and Quality sponsored a review of CRC screening implementation in primary care and a program of research funded by these organizations. The evidence base for improving CRC screening supports the value of a New Model of Primary Care Delivery: 1. a team approach, in which responsibility for screening tasks is shared among other members of the practice, would help address physicians' lack of time for preventive care; 2. information systems can identify eligible patients and remind them when screening is due; 3. involving patients in decisions about their own care may enhance screening participation; 4. monitoring practice performance, supported by information systems, can help target patients at increased risk because of family history or social disadvantage; 5. reimbursement for services outside the traditional provider-patient encounter, such as telephone and e-mail contacts, may foster enhanced screening delivery; 6. training opportunities in communication, cultural competence, and use of information technologies would improve provider competence in core elements of screening programs. Improvement in CRC screening rates largely depends on the efforts of primary care practices to implement effective systems and procedures for screening delivery. Active engagement and support of practices are essential for the enormous potential of CRC screening to be realized.

Equity of colorectal cancer screening: which groups have inequitable participation and what can we do about it?

“…Studies in the UK which use sigmoidoscopy as the method of CRC screening also highlight the importance of GP endorsement and recommendation (Brotherstone, Vance, Edwards, Miles, Robb, Evans et al, 2007;McCaffery, Borril, Williamson, Taylor, Sutton, Atkin et al, 2001;Power, Van Jaarsveld, McCaffery, Miles, Atkin, & Wardle, 2008;Robb, Power, Kralj-Hans, Edwards, Vance, Atkin et al, 2010;Sutton, Wardle, Taylor, McCaffery, Williamson, Edwards et al, 2000), although the relevance of these studies may be questioned due to the different type of CRC screening test used. Nevertheless, If the potential benefits of bowel cancer screening are to be realised, GPs must be actively engaged (Damery et al, 2010;Klabunde, Lanier, Breslau, Zapka, Fletcher, Ransohoff et al, 2007;Zajac et al, 2010). Within our study, the engagement of and endorsement by GPs and nurse practitioners in the program and offering the screening test through them were highly recommended by the Anglo-Australian participants.…”

A Randomized Controlled Trial to Improve Colon Cancer Screening in Rural Family Medicine: An Iowa Research Network (IRENE) Study

“…This article supports the notion that providing offices with support for CRC screening leads to improved CRC screening rates. 23,35,49,[52][53][54] Interpretation It has been estimated that 50% to 80% of CRCs could be prevented with appropriate screening. [1][2][3][4][5][6] Screening rates are lower in socioeconomically disadvantaged and rural populations.…”

Mailed Fecal Immunochemical Tests Plus Educational Materials to Improve Colon Cancer Screening Rates in Iowa Research Network (IRENE) Practices

“…Given the results of this work and others, it seems clear that providing offices with support for CRC screening leads to improved CRC screening rates. 31,[35][36][37][38][39] Weaknesses include participation bias in that individuals with no interest in CRC screening likely would not agree to participate. In addition, patients were recruited from family physician offices and thus had access to medical care.…”